Antineutrophil cytoplasmic antibodies in patients with pulmonary tuberculosis

Mycobacterium tuberculosis is a major cause of mortality and morbidity worldwide. Infection with this bacterium is known to induce the development of autoantibodies of which a few are also known to be diagnostic markers for some other diseases. antineutrophil cytoplasmic antibodies [ANCA's] are among those autoantibodies used in clinical setting for diagnosing systemic vasculitic syndromes. Multiple studies investigated ANCA positivity in diseases other than small vessel vasculitis. This study was performed to determine the prevalence of ANCA in pulmonary tuberculosis [TB] which may lead to the false diagnosis of Wegener's granulomatosis [WG] or vice versa. In a case-control study, 32 consecutive smear positive pulmonary TB patients and 32 normal individuals were studied. All cases and controls were screened for ANCA by indirect immunofluorescent assay [IIF], and MPO and PR3 were also tested by ELISA. A prenuclear pattern [P-ANCA] was detected in 25% of the cases and 6.25% of the controls and a cytoplasmic pattern [C-ANCA] was deserved in 3.1% of both the cases and the controls by IIF assay. ANCA specificities tested by ELISA in cases revealed that 75% of the cases had anti-MPO and 12.5% had anti-PR3, while in the in controls, 3.12% had anti-MPO and none had anti-PR3. The positive ANCA significantly correlated with TB [p<0.01]. ANCA's may be observed in both TB and systemic vasculitic syndromes such as WG. Tuberculosis and WG share some clinical features. Therefore, in countries with a high prevalence of TB, one has to distinguish between these two diseases especially when no sign of extrapulmonary involvement is observed

Emergence of cefepime resistance in gram-negative induced nosocomial infections

The rapid emergence of antibiotic resistance, especially broad-spectrum antibiotics, resulted in the avid use of new potent antibiotics. Ceftriaxone and ceftazidime, two third-generation cephalosporin, are usually used to manage complicated and uncomplicated infections. The use of cefepime in resistant infections is increasing gradually, which put this potent antibiotic at risk of resistance. During an 18-month period, a total of 220 gram-negative bacteria including Pseudomonas spp, Serratia spp, Acinetobacter spp, Proteus spp, E-coli and Kiebsiella spp. have been isolated by standard microbiological methods from nosocomial surgical site, abscess, blood stream and urinary tract infections. MIC of antibiotics on isolated bacteria was determined by gradient concentration method. Totally, 29.4%, 19.5% and 23.3% of isolated bacteria with MIC /= 256micro g/ml to cefepime, cefiriaxone and ceftazidime was also observed in 47.1%, 70.8% and 62.5% of cases, respectively [p<0.05]. High level resistance to cefepime were more commonly observed for pseudomonas [73.1%] and Klebsiella spp. [73.5%], respectively [p<0.05]. According to CLSI criteria, 47.1% of isolated bacteria in this study showed high level of resistance [MIC >/= 256micro g/ml] to cefepime. Therefore application of cefepime, as a drug of choice, for gram-negative organisms is not reasonable. Our result demonstrated that this potent antibiotic should not be used as a choice for empiric antibiotic therapy, in the cases of nosocomial infections caused by gram-negative organisms